Rates Table Template AWS
2015 Rates Table Template v4.0
To validate press Validate button or Ctrl + Shift + V. To finalize, press Finalize button or Ctrl + Shift + F.
Go to cell B1 for instructions
If you are a community rating state, select Family Option under Age and fill in all columns. If you are not community rating state, select 0-20 under Age and provide an Individual Rate for every age band. If Tobacco is Tobacco User/Non-Tobacco User, you must give a rate for Tobacco Use and Non-Tobacco Use. To add a new sheet, press the Add Sheet button, or Ctrl + Shift + S. All plans must have the same dates on a sheet. HIOS Issuer ID* Federal TIN* 66-0219758 Rate Effective Date* Rate Expiration Date*
77944 1/1/2015 12/31/2015
MENONITA MAX-MXP01 GOLD 1
Plan ID*
Rating Area ID*
Tobacco*
Age*
Individual Rate*
Individual Tobacco Rate*
Required: Enter the 14-character Plan ID
Required: Select the Rating Area ID
Require: Select if Tobacco use of subscriber is used to determine if a person is eligible for a rate from a plan
Required: Select the age of a subscriber eligible for the rate
Required: Enter the rate of an Individual NonTobacco or No Preference enrollee on a plan
Required: Enter the rate of an Individual tobacco enrollee on a plan
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
77944PR0010002
Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
77944PR0010002
Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User
0-20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 and over
77.04
92.45
121.32
145.59
121.32
145.59
121.32
145.59
121.32
145.59
121.81
146.17
124.23
149.08
127.15
152.58
131.88
158.25
135.76
162.91
137.70
165.24
140.61
168.74
143.52
172.23
145.34
174.41
147.29
176.74
148.26
177.91
149.23
179.07
150.20
180.24
151.17
181.40
153.11
183.73
155.05
186.06
157.96
189.55
160.75
192.90
164.63
197.56
169.49
203.39
175.19
210.23
181.98
218.38
189.63
227.55
198.36
238.04
206.98
248.37
216.68
260.02
226.27
271.52
236.82
284.19
247.50
297.00
259.02
310.83
270.55
324.66
283.05
339.65
295.66
354.80
309.13
370.96
315.80
378.96
329.27
395.12
340.92
409.10
348.56
418.27
358.14
429.77
363.97
436.76
363.97
436.76
To validate press Validate button or Ctrl + Shift + V. To finalize, press Finalize button or Ctrl + Shift + F.
Go to cell B1 for instructions
If you are a community rating state, select Family Option under Age and fill in all columns. If you are not community rating state, select 0-20 under Age and provide an Individual Rate for every age band. If Tobacco is Tobacco User/Non-Tobacco User, you must give a rate for Tobacco Use and Non-Tobacco Use. To add a new sheet, press the Add Sheet button, or Ctrl + Shift + S. All plans must have the same dates on a sheet. HIOS Issuer ID* Federal TIN* 66-0219758 Rate Effective Date* Rate Expiration Date*
77944 1/1/2015 12/31/2015
MENONITA MAX-MXP01 GOLD 1
Plan ID*
Rating Area ID*
Tobacco*
Age*
Individual Rate*
Individual Tobacco Rate*
Required: Enter the 14-character Plan ID
Required: Select the Rating Area ID
Require: Select if Tobacco use of subscriber is used to determine if a person is eligible for a rate from a plan
Required: Select the age of a subscriber eligible for the rate
Required: Enter the rate of an Individual NonTobacco or No Preference enrollee on a plan
Required: Enter the rate of an Individual tobacco enrollee on a plan
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
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Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
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Rating Area 1
77944PR0010002
Rating Area 1
77944PR0010002
Rating Area 1
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Rating Area 1
77944PR0010002
Rating Area 1
Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User Tobacco User/NonTobacco User
0-20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 and over
77.04
92.45
121.32
145.59
121.32
145.59
121.32
145.59
121.32
145.59
121.81
146.17
124.23
149.08
127.15
152.58
131.88
158.25
135.76
162.91
137.70
165.24
140.61
168.74
143.52
172.23
145.34
174.41
147.29
176.74
148.26
177.91
149.23
179.07
150.20
180.24
151.17
181.40
153.11
183.73
155.05
186.06
157.96
189.55
160.75
192.90
164.63
197.56
169.49
203.39
175.19
210.23
181.98
218.38
189.63
227.55
198.36
238.04
206.98
248.37
216.68
260.02
226.27
271.52
236.82
284.19
247.50
297.00
259.02
310.83
270.55
324.66
283.05
339.65
295.66
354.80
309.13
370.96
315.80
378.96
329.27
395.12
340.92
409.10
348.56
418.27
358.14
429.77
363.97
436.76
363.97
436.76
